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I have a patient who I am very fond of, but our appoint- ment always starts the same way. He will walk in to the room and immediately announce that I am going to be annoyed with him and disappointed at the state of his mouth. Hackles raised, I calmly reply that no, I won’t be annoyed or disappoint- ed with him, as it is his health not mine. He sometimes even says: “I know what you are going to say, that you are not cross with me, but it must be disappointing to have a patient like me.” After un- clenching my jaw, I reply that if there is any disappointment, it is because you feel so guilty at let- ting me down. After a few minutes of this, he usually says: “Yes, I know it is my health, and I am only letting myself down, but how can you not care? You are such a hard woman.” I explain that I have more than 1,000 patients whom I treat and I cannot be respo- nsible for each individual’s health, as it would be too heavy a burden for my shoulders. This does not mean I do not have em- pathy for patients. I do care; just not on the level he would like me to. Same old score We then do our usual bleed- ing score and BPE, followed by plaque score, all of which are in the ‘just getting away with it’ section and have been there for over a year now. Once he sees he is not getting worse he is more relaxed and we go over all his hygiene routine, usually decid- ing that all is manageable and it is just a case of implementing it regularly. As a highly intelligent law- yer, he is used to fighting his corner and I have not found a way of breaking this cycle we have fallen into. We discussed it after our last appointment and he said it was his own need to succeed at everything that led him to be hard on himself about his own hygiene. So, after our last maintenance session a few weeks ago I have been looking into ways of dealing with this cycle so we can both progress and I can keep my blood pres- sure where it belongs. How to deal with difficult patients I am loathe to use this as a head- ing, because I am so fond of this patient and his family. But, it is a tiring start to the day (he is always an 8am patient) and if I can make it easier for both of us, it would be good. I also be- lieve the only way we can make progress is to stop this cycle. So here are a few this we should avoid: • Don’t take difficult patients’ behaviour personally. It is often habitual and affects most people with whom they come in con- tact. This does not mean they Dealing with difficult patients How do we care for our more awkward patients without giving in to their demands and having to care for them too much? Mhari Coxon finds out how to strike the balance ‘We have to guide them to a state of awareness of a need to change before we can begin to introduce choices for them.’ ITI Education Week, London. Current Treatment Principles and Concepts in Implant Dentistry Date November 22–27, 2010 Difficulty level Straightforward, Advanced and Complex Language English Course director Professor Nikos Donos, Head and Chair of Periodontology, UCL Eastman Dental Institute Course fee £2,750 (incl. day-time catering, handouts and course material) Discounts ITI Fellows/Members: 10% Current ITI Scholars: on request No. of participants Max. 20 CPD hours 39 Accommodation Hotel information will be provided after registration To register contact: ITI Team for Implantology ITI Education International Peter Merian-Weg 10 CH-4052 Basel, Switzerland education@iticenter.ch www.iti.org/educationweek Tel: +41 61 270 83 97 Fax: +41 61 270 83 84 The ITI University Programme The ITI – International Team for Implantology – is an independent academic organisation dedicated to advancing knowledge in the field of implant dentistry. The ITI University Programme aims to enhance implant education worldwide by offering coordinated, high quality, commercially independent, continuing education in implant dentistry around the globe. UCL Eastman Dental Institute The UCL Eastman Dental Institute is a major centre of excellence at the forefront of evidence-based clinical service, research and education in the oral health care sciences. Course details This six-day ITI Education Week has been designed for clinicians who wish to acquire further knowledge in basic and advanced treatment techniques in implant dentistry through an evidence- based approach. The course will be delivered through lectures, surgical and prosthodontic hands-on workshops, exposure to live procedures and interactive treatment planning sessions. Topics Current principles of bone and soft tissue integration around dental implants Patient risk assessment (surgical and prosthodontic aspects) Smile design and treatment planning considerations for patients with demanding aesthetic needs Advanced treatment planning using radiographs and 3D imaging (lecture and workshops on radiographs and 3D images) Prosthodontic principles and loading protocols in implant dentistry Basic surgical and prosthodontic workshop (tissue level & bone level implants) Guided bone regeneration Alveolar ridge preservation vs. immediate implants Piezoelectric bone surgery for intra-oral bone grafting and implant site preparation Advanced soft tissue management by means of periodontal plastic surgery Provisional restoration and final prosthesis in the aesthetic zone Implants in periodontal and systemically compromised patients Management of peri-implantitis and supportive/maintenance therapy Case presentations with interactive treatment planning exercises and case discussions www.eastman.ucl.ac.uk www.iti.org 4681 ITI Education Week Ad:4681 ITI Education Week Ad 21/5/10 16:41 Page 1 June 28-July 4, 201024 United Kingdom EditionDCPs